Abdomen: Mildly distended. Suggestion of a mass in the right lower quadrant.
Rectal: No palpable masses, stool was hemoccult negative.
Hematocrit: 32. Mean Corpuscular Volume: 105
White Blood Cell Count: 11,500 with a normal differential count
Erythrocyte Sedimentation Rate: 35 mm/hr (Normal 0-20 mm/hr)
An Upper GI series revealed a stricture of the terminal ileum.
Colonoscopy revealed a normal rectum, sigmoid, and descending colon. The transverse colon had two separate patches of erythema. The ascending colon was normal. The cecum had a patch of erythema. The terminal ileum was entered through the ileocecal valve. However, the colonoscope could not be advanced any further into the ileum due to an ulcerated stricture just proximal to the ileocecal valve. A biopsy of the stricture was obtained. Pathology report revealed non-caseating granulomas, areas of ulceration, and a lymphocytic cellular infiltrate in the lamina propria.
What is the normal hematocrit for females? What is the normal mean corpuscular volume for red blood cells? Based on this information, would you say that Shannon has a microcytic or macrocytic anemia?
- Explain the value of knowing that Shannon’s symptoms were not related to dairy products or the fact that she had not traveled recently.
- What is the normal hematocrit for females? What is the normal mean corpuscular volume for red blood cells? Based on this information, would you say that Shannon has a microcytic or macrocytic anemia?
- Shannon’s case has two major clues that implicate a specific vitamin deficiency causing her anemia. What are the clues?
- What abdominal or pelvic organs might produce right lower quadrant pain?
- What is the name of the disease that Shannon has in her intestines? Give evidence to support your diagnosis.